胰腺囊性病变的影像诊断课件

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1、CYSTICLEISIONSOFPANCREASPHD.MD.ZHENSHENMATHEIMAGINGDEPARTMENTOFSHANDONGPROVENCEQIANFOSHANHOSPITALIntroductionClassificationSystematicApproachMRIversusCTSmallpancreaticcystsHowtoreportManagementPseudocystCysticNeoplasmsAgeandgenderSerouscysticneoplasmMucinousCysticNe

2、oplasmaIntraductalPapillaryMucinousNeoplasmMain-ductIPMNBranch-ductIPMNUncommonNeoplasmswithspecificfindingsSolidPseudopapillaryNeoplasmNeuroendocrinetumorwithcysticdegenerationClassificationPancreaticcystscanbecategorizedintothefollowinggroups:PseudocystsCommoncyst

3、icneoplasms:IPMN-intraductalpapillarymucinousneoplasmSCN-SerouscysticneoplasmMCN-MucinouscysticneoplasmUncommoncysticneoplasms:SPEN(solidpseudopapillaryepithelialneoplasm)Tumorswithcysticdegeneration:adenocarcinoma-neuroendocrinetumorSystematicApproachWhenacysticpan

4、creaticlesionisdetected,thefirststepistodecidewhetherthelesionismostlikelyapseudocystoracysticneoplasm.Thisschemeisasimplifiedroadmapforthedifferentiationofpancreaticcysts.Pseudocyst–Thinkpseudocystwhenthereisahistoryofpancreatitis,alcoholabuse,stonediseaseorabdomin

5、altraumaandthelesionisunilocularorcontainsnon-enhancingdependentdebris.Cysticneoplasm-Thinkofthepossibilityofacysticneoplasm,whenthereisnohistoryofpancreatitisortrauma,orwhenthecysthasinternalsepta,asolidcomponent,centralscarorwallcalcification.Mucinouscysticneoplas

6、m-Thisisusuallyaunilocularcystfilledwithmucinsometimeswithwallcalcification,exclusivelyseeninwomen.Serouscysticneoplasm-Thisisamicrocysticlesion,thatconaintsserousfluidwithsometimesacharacteristicscarwhichmaycalcify.Itcanlooklikeabranch-ductIPMN,butSCNhasnocommunica

7、tionwiththepancreaticduct.Thetypicalappearancemakesaspecificdiagnosispossible,whichisimportant,becauseSCNistheonlytumorthatisnotpremalignant.Branch-ductIPMN–ThistumorcanlooklikeaSCN,buthasnoscarorcalcifications.MRCPorheavilyweigtedT2WImayshowtheconnectiontothepancre

8、aticduct,whichishighlyspecific.TheleftCT-imageisofapatientwithahistoryofpancreatitis.Therearetwounilocularorsimplecysts.Noticealsotheretro